Case #41: Man in his 60s from Suginami, taxi driver (trifocal multifocal lens: PanOptix)

Cataracts had been pointed out two years earlier and he was being monitored at another clinic, but he first visited us wishing for cataract surgery with a multifocal lens covered by advanced medical care insurance. The left eye had reduced vision from an anterior polar cataract with dense anterior subcapsular opacity and anterior capsule fibrosis, so we judged surgery to be indicated; but he works as a taxi driver, so we considered multifocal candidacy carefully. We first recommended LENTIS Comfort, with a low add that still secures the car navigation distance, or the bifocal ActiveFocus, which causes relatively few halos and glare; but he strongly wished for surgery with the trifocal PanOptix, so we operated after telling him that, depending on circumstances, an exchange for a monofocal lens after surgery might be needed.
As for the surgery, he was taking medication for an enlarged prostate, but intraoperative floppy iris syndrome (IFIS) was mild and the surgery was completed without problems.
From early on after surgery he was very satisfied with good uncorrected vision of 1.2 distance / 1.0 near, and the feared halos and glare when driving at night were no hindrance to driving at all, at a level that did not bother him. The right eye's cataract was relatively mild and there was little difference in refraction between the eyes, so at first only single-eye surgery was planned, but after the left eye surgery he strongly wished to have the right eye done too, and he was very satisfied with good uncorrected vision there as well, 1.5 distance / 1.2 near.
How halos and glare are perceived varies with pupil size, residual astigmatism and individual sensitivity, but the closer postoperative refraction is to 0.00 D (emmetropia), the less unpleasant they seem to be; this case reaffirmed the importance of setting an appropriate target refraction and of accurate preoperative testing to prevent postoperative refractive error.